What is the effectiveness of Decadron (dexamethasone) in a 14-month-old infant presenting with retraction breathing, cough, and fussiness, but no fever?

From the Guidelines

Decadron (dexamethasone) should not be given to a 14-month-old with retractions and cough without medical supervision, as it may have adverse effects on neurodevelopmental outcomes, and the child needs immediate evaluation to determine the cause of respiratory distress. Retractions (when the skin pulls in between the ribs during breathing) indicate respiratory distress, which can be serious in young children. While dexamethasone is sometimes used for croup (characterized by a barking cough and breathing difficulties), it should only be given under medical supervision with proper dosing, as high daily doses of dexamethasone have been linked to adverse neurodevelopmental outcomes 1. The absence of fever doesn't rule out a serious condition, and the child needs evaluation to determine the cause of the respiratory distress, which could range from croup to bronchiolitis, asthma, or other conditions. Each requires different treatment approaches.

Some key points to consider:

• The child's symptoms, such as retractions and cough, require immediate medical attention to determine the underlying cause and provide appropriate treatment.
• Dexamethasone may be considered as part of the treatment plan, but only under medical supervision and with proper dosing.
• The child's age and medical history should be taken into account when determining the best course of treatment.
• A systematic approach to determining the cause of the cough, such as using a validated guideline, is recommended 1.
• Treatment should be based on the etiology of the cough, and a trial of therapy may be appropriate in some cases, but the child should be followed up and medications ceased if there is no effect on the cough within an expected timeframe 1.

In terms of management, the following steps can be taken:

• Seek immediate medical attention for the child to determine the cause of respiratory distress.
• Provide a thorough medical history and physical examination to determine the underlying cause of the cough.
• Consider a trial of therapy, such as a short course of beclomethasone equivalent, if risk factors for asthma are present, but always re-evaluate the child in 2 to 4 weeks 1.
• Follow up with the child regularly to monitor the effectiveness of treatment and adjust the treatment plan as needed.

From the Research

Symptoms and Diagnosis

• The child is experiencing retraction breathing, cough, and fussiness without fever, which are common symptoms of respiratory distress 2.
• The symptoms can be caused by various conditions, including upper airway obstruction, pneumonia, lower airway obstruction, or other respiratory issues 2.
• A thorough evaluation is necessary to determine the underlying cause of the symptoms and to rule out any serious underlying conditions 3.

Treatment Options

• Decadron (dexamethasone) is a corticosteroid that may be used to treat respiratory distress, but its effectiveness and potential side effects should be carefully considered 4, 5.
• The use of dexamethasone in acute respiratory distress syndrome (ARDS) has been shown to reduce the duration of mechanical ventilation and mortality, but it may also increase the risk of ventilator-associated pneumonia 5.
• In children, the management of acute cough is typically based on a "wait, watch, review" approach, and the use of over-the-counter cough and cold medications is not recommended due to the risk of side effects and adverse reactions 3.

Respiratory Support

• Continuous Positive Airways Pressure (CPAP) and mechanical ventilation may be required in some cases to support the child's breathing 2.
• The choice of respiratory support will depend on the severity of the child's symptoms and the underlying cause of the respiratory distress 2.